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CM III Exam III > Prenatal Diagnosis and Care > Flashcards

Prenatal Diagnosis and Care Flashcards

1
Q

Gestational Age

A

Days-weeks from LMP

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2
Q

Embryo

A

What we call the spermegg from time of fertilization to 8wks (GA 10wks)

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3
Q

Fetus

A

What we call the spermegg after 8 wks until time of birth

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4
Q

Infant

A

Time between delivery and 1yr old

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5
Q

First trimester

A

1-14wks GA

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6
Q

Second Trimester

A

14-28wks GA

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7
Q

Third Trimester

A

28wks until delivery

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8
Q

Previable

A

Infant delivered before 24wks

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9
Q

Preterm

A

Infant delivered 24-37 wks

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10
Q

Term

A

37-42 wks

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11
Q

Post Term

A

> 42 wks (yikes)

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12
Q

Parity

A

Number of pregnancies that led to a birth after 20 weeks

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13
Q

What counts in parity? (if it’s after 20 weeks)

A

Term
preterm
Abortions
Living children

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14
Q

When is an S3 gallop physiologic

A

Pregnancy! It’s due to the inc BV. The output, stroke and pulse will also jump up bc of this extra blood

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15
Q

BP changes in pregnancy

A

In the second trimester we’ll take a dip in BP, it’ll come back to normal in the third trimester.

This is due to changes in peripheral vascular resistance

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16
Q

Where does the bladder go during pregnancy?

A

Down and in! It becomes an intra-abdominal organ during pregnancy.

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17
Q

Kidney function changes in pregnancy

A

GFR will increase by 50% dt the extra blood
BUN and serum Cr will decrease by 25%
Marked inc in renin and angiotensin, but a reduced vascular sensitivity to their hypertensive effects

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18
Q

Hematologic changes in pregnancy

A

Plasma volume inc by 50%
RBC volume inc by 30%
*WBC count increases- think about the proinflammatory response that goes along with pregnancy
Platelet count dec but is still WNL

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19
Q

Cervix changes in pregnancy

A

Inc cervical muscous secretions

Inc water content and vascularity

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20
Q

Where do we expect the fundus to be @ 20 wks

A

Tip of the umbilicus

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21
Q

What does it mean when the baby “drops”

A

It means the baby’s head is engaging with the pelvis

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22
Q

Serum or urine HCG? When will we see a positive result?

A

Uguale! Serum and urine are just as sensitive.

They can be positive 1 week after fertilization, which is one week before you miss your period.

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23
Q

How to determine if it’s a viable pregnancy

A

US and HCG

5 weeks: TvUS can show a gestational sac or HCG of 1,500-2,000

6 weeks: TvUS can show afetal heart or an HCG of 5,000-6,000

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24
Q

Two questions you should ask every patient before you do anything else

A

1) Was this pregnancy planned

2) Are you planning to continue this pregnancy?

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25
Q

1 leading cause of pregnancy leading death. What are the RF for it

A

DV- Homicide.

RF are age <20, AA, late or no prenatal care

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26
Q

Pregnancy signs

A 
Chadwick's sign
Hegar's sign
Goodell's sign
Ladin's sign
Breast swelling/tenderness
Linea nigra
Telangiectasias
Palmar erythema
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27
Q

Chadwick’s sign

A

Bluish discoloration of the vagina and cervix

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28
Q

Hegar’s sign

A

Softening of the uterine consistency and ability to palpate or compress the connection between the cervix and the fundus

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29
Q

Goodell’s sign

A

Softening and cyanosis of the cervix after week 4

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30
Q

Ladin’s sign

A

Softening of the uterus after week 6

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31
Q

Symptoms of pregnancy (different than signs)

A

Amenorrhea
N/V
Breast pain
Quickening (fetal movement)

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32
Q

Initial PE for a pregnancy woman

A 
Vitals
Thyroid
heart
Lungs
Breast
Abdomen
Pelvic (Pap, GC, bimanual)
Extremities-edema**
Influenza vax
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33
Q

Nagele’s Rule

A

For calculating the EDD

LMP - 3 months + 7 days

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34
Q

How to calculate the EDD when LMP is unknown

A

US!

Most accurate in first trimester. Done by measuring CML, can predict is with an error of 3-5 days

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35
Q

Labs in the first trimester

A 
CBC
Type and Screen
RPR/VDRL -> syph
Rubella Ab screen
HBV antigen
VZV titer
G/C cx
PPD
Pap
UA and U Cx
HIV testing
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36
Q

CBC in pregnancy

When is it done?
What do we expect the WBC to look like?
RBC?
MCV?
Thrombocytopenia?
A 
Done with initial labs and at 28 weeks
Slightly elevated WBC
Dilutional anemia normal
MCV low? Consider thalassemia
Slight thrombocytopenia is normal
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37
Q

When to transfuse iron dt dilutional anemia in pregnancy

A

When HCT <32%

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38
Q

When do we get worried about HELLP w/ thrombocytopenia

A

When Plt <100

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39
Q

Type and Screen in regards to Rh/rhogam

A

All Rh - moms get rhogam at 28 weeks

Rh - moms with a + baby will get rhogam PP

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40
Q

When to do a test of cure for G/C in a pregnant woman

A

4 weeks after tx. We want to make sure this doesn’t get passed onto the baby

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41
Q

Non Trep Syph testing (it’s the weird acronym)

A

VDRL/RPR

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42
Q

Trep Syph testing (acronyms again)

A

FTA-ABS

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43
Q

RF for a false positive for VDRL/RPR , and what to do when you get a false pos

A

Being pregnant is a risk factor! If this is positive, do the (more expensive) trep syph testing and get a FTA-ABS

44
Q

Risks of untxed syphilis for baby

A

Miscarriage, stillbirth, neonatal death or baby with severe neurological problems. 50% of untxed syph winds up passing to the baby

45
Q

Guide to screening for cystic fibrosis/when to be worried

A

If mom is a carrier, screen dad.
If dad is not a carrier, we’re not worried.
If mom and dad is a carrier, be worried

46
Q

What is MS-AFP

A

Maternal Serum AFP level. High levels can be a marker for neural tube defects, but it’s far from perfect. 5% false pos rate and only 85% proper detection rate

47
Q

What defines AMA and what kind of screening do we offer these patients

A

> 35 yo.

Offer maternal serum screening and genetic counseling with diagnostic tests (chorionic sampling or amnio)

48
Q

Modes of maternal serum screening

A

MS-AFP
Quad screen
Sequential screening
NIPT testing (non invasive prenatal testing- blood test for downs etc)

49
Q

Are the screening tests diagnostic? If they’re positive, what are the next steps?

A

No! They’re just for screening. If they’re positive we’ll do actual diagnostic screening (LvL 2 US, amnio, chorionic)

50
Q

Second trimester diagnostics (everybody gets these)

What weeks do people get these?

A

MSAFP (16-18wks)
Quad screen
US (18-20wks)

51
Q

What can an ultrasound show you at 18-20wks

A

A lot of soft markers for bad stuff.

We’ll do a fetal survey, get an amniotic fluid volume, placental location and gestational age

52
Q

What does a quad screen test for?

Can it be used if multiple gestation?

A

Tests for Trisomy 21, Trisomy 18 and open NTD

Cannot be used for multiple gestations.
Not diagnostic, send for L2 US and amnio if positive

53
Q

What makes up sequential screening?

A

1) Blood tests for serum PAPP-A and HCG @ 11-13wks
2) US for nuchal translucency @ 11-13wks
3) More blood tests for MS-AFP, estriol, HCG, inhibin @ 15-18wks*** This second round of blood tests is much more sensitive than the first round.

54
Q

False positive rate of sequential screening

A

1%. It’s really good

55
Q

US Soft markers for aneuploidy

A

Ventricular septal defect
Choroid plexus cyst
Thickened nuchal fold

56
Q

Is cffDNA diagnostic? What’s the next step after this

A

It’s considered diagnostic, but we’d still do amnio after a positive.

57
Q

What is cffDNA analysis? What does it check for?

A

Cell-free Fetal DNA analysis. Tests for fetal trisomies using mom’s blood. Checks for trisomy 21, 18 and 13.

58
Q

Recommendations for testing cffDNA

A

1) AMA
2) US soft markers for aneuploidy
3) Hx of pregnancy w/ trisomy
4) Positive test result for trisomy from quad/sequential screen

59
Q

When do we do an US in pregnancy

A

1) Initial visit to measure CRL if uncertain LMP
2) First trimester bleeding
3) Anatomic survey @ 20 weeks
4) any time fundal height >3cm discrepancy from GA
5) Confirm presentation at/after 37 weeks

60
Q

What is amniocentesis

A

Sticking a needle in the sac while under US guidance to tell us some more about what’s going on with the kiddo

61
Q

When is amniocentesis done & why

A

Amnio is traditionally done at 15-20weeks to get a fetal karyotype. Should not be done <15 weeks because there’s a much higher risk of pregnancy loss.

62
Q

What determines the rate of procedure-related fetal loss

A

Provider experience

63
Q

Complications of amnio

A 
Transient vaginal spotting
Amniotic fluid leakage
Preterm labor
Chorioamnionitis
Needle injury to fetus
64
Q

What is chorionic Villus Sampling?

A

It’s when you place a cath into the intrauterine cavity and aspirate a small amount of chorionic villi from the placenta. Can get you a fetal karyotype 5 weeks before an amnio

65
Q

Complications of Chorionic villus sampling?

A

Preterm labor
PROM
Previable delivery
Fetal injury

66
Q

What has a higher risk of procedure-related fetal loss, amnio or chorioinic villus sampling?

A

It’s the same as long as your in the hands of an experienced provider

67
Q

What is cordocentesis?

A

PUBS! Puncture the umbilical vein under US guidance and get a direct blood sample. Gets us a fetal karyotype. Rarely done for diagnostics, but can be used to further evaluate chromosomal mosaichism as a last resort

68
Q

Procedure-related pregnancy loss of cordo

A

<2%

69
Q

Third trimester standard diagnostics. (blood tests)

When is it done?

A

Done at 27-29 weeks.

CBC- check for dilutional anemia
GLT (glucose loading test)
RPR/VDRL
CXR if PPD +
GBS strep cx at 36wks

High risk? Consider repeat G/C/HIV

70
Q

Two methods of testing for GDM (gestationaln diabetes mellitus)

A

1) Glucose loading test -> screening tool. If positive, do GTT
2) Glucose Tolerance Test -> Diagnostic tool

71
Q

Glucose loading test (GLT)

A

Give 50g PO glucose as a loading dose and check serum glu 1hr later

72
Q

Glucose Tolerance Test (GTT)

And what’s considered a positive result?

A

Get a fasting serum glucose. Then give 100g PO glucose loading dose. Do serial serum glucoses at 1,2 and 3 hrs after PO glu.

If >2 of these values are elevated it’s a diagnosis for GDM

73
Q

Positive values for elevated glucose levels in a GTT

A

Fasting >95
1hr >180
2hr >155
3hr >140

74
Q

What to get at routine prenatal visits

A 
BP
Weight
Urine dip for protein/glu
Fundal height, estimated weight &amp; position
Auscultation of fetal heart tones
75
Q

When to screen for GBS
How to screen for GBS
What do we use to tx GBS
What if they’re allergic

A

1) 36 wks
2) Vagina/anus swab
3) PCN
4) Vanco. Make sure they’re actually allergic

76
Q

How often do we see these pregnant women

a) When they’re <28wks (before 3rd trimester)
b) When they’re 28-36 wks (third trimester to term)
c) >36 wks (term)

A

a) <28 weeks? Once a month
b) 28-36 wks? Twice a month
c) Term? Once a week

77
Q

Questions for a pregnant woman in the first trimester

A

Cramping?
Bleeding?- spotting is normal
N/V?

78
Q

Q’s for a pregnant woman in the second trimester

A

Cramping?
Bleeding?- spotting is definitely not normal
Fetal movement?

79
Q

Q’s for a pregnant woman in the third trimester

A

Contractions?
Any bleeding?- we might see a tiny bit of spotting in the third trimester since the cervix is SO vascular. But we should still bring these women in.
Leaking of fluid?
Baby still moving?

80
Q

Routine Problems in Preg (the ones she actually said out loud)

A

PICA- get a nutrition consult
Round ligament pain (esp common if 1st pregnancy)
Urinary freq (can also be a UTI, get a dip)
Carpal tunnel syndrome (will clear up ~6wks PP)

81
Q

How much folic acid do our ladies need

A

800mcg, most effective when given 2 months prior and during 1st month. Better to get it from dietary sources

82
Q

What vitamins should our ladies avoid

A

Fat soluble ones! DAKE

83
Q

Limiting caffeine in pregnancy

A

<500mg a day

84
Q

When to consider a nutrition referral in a pregnant patient

A

Not enough weight gain
PICA
Eating disorder

85
Q

Prenatal nutrition, how much __ should a pregnant woman be getting per day

a) Calories
b) Protein
c) iron
d) calcium

A

a) 2,200
b) 75g total
c) 30-60 mg
d) 1200 mg

86
Q

How much weight do we expect you to gain in pregnancy?

How much if you’re obese (BMI>30)
How much if you’re underweight (BMI<20)

A

Avg is 25-35 lbs. Every organ volume will inc in weight. Like just the extra blood is 4lb

Obese? 15lb
Underweight? 40lb

87
Q

How much do we want to limit radiation exposure in pregnant women

A

5 episodes max

88
Q

Some safe “go to” meds for pregnant ladies

A 
Prenatal Vitamins
Tylenol
Benadryl
Sudafed (if no HTN)
Tums
FeSO4
Colace
89
Q

For UTI, we can use ___ all the way until the third trimester. Third trimester we use ___

A

Bactrim until third trimester, after that it’s macrobid. Or just macrobid throughout

90
Q

When do we talk about PP contraception

A

Third trimester

91
Q

Goals of antepartum fetal surveillance

A

Prevent fetal death

92
Q

Forms of antepartum fetal surveillance

A 
Fetal movement assessment
NST
Contraction stress test
Fetal biophysical profile
Amniotic fluid index
93
Q

Fetal movement assessment:
Indication?
Technique?

A

Indication: Mom perceives dec fetal movement
Technique: Mom counts number of kicks in a specific amount of time. Have mom eat/drink and then sit or lie down

94
Q

Non Stress test

1) What is it?
2) What’s considered a reactive result?
3) What’s considered a nonreactive result?

A

1) Measure of fetal HR w/ movement. The HR of a healthy infant will temporarily accelerate when the kid moves
2) Reactive (normal) = >2 fetal HR accelerations within 20 min
3) Non reactive: Insufficient HR accel within 40 min

95
Q

Contraction Stress test-

What are we looking for?

A

We’re looking for the presence/absence of late fetal HR decel in response to uterine contractions

96
Q

What is a late decel?

A

Decel that hit nadir after then peak of the contraction, and drag on a little bit after the end of the contraction. This aren’t good

97
Q

What is a variable decel?

A

Decels for no reason. Cord compression, can be a lot of things. Not as big of a worry

98
Q

What makes up a biophysical profile (like a fetus well being check). How is it scored?

A

NST, fetal breathing movements, fetal movement, fetal tone, amniotic fluid index.

Scored from 0-10. Normal is 8-10, equivocal is 6, bad is <4

99
Q

Regardless of the composite score, if ____ is present we want further evaluation

A

Oligohydraminos

100
Q

Oligohydraminos

A

No US measured pocket of fluid that’s >2cm. Or we have an overall amniotic fluid index <5cm. This is always bad, there is not enough fluid for the baby and it’s a sign that the placenta has his it’s expiration date

101
Q

Polyhydraminos

A

When AFI >24cm. It’s when there’s excess fluid. This can be totally normal, or it can cause PROM and malpresentatino

102
Q

When do we start antepartum surveillance?

A

Between 32-34 weeks for most pregnancies. Start at 31 weeks if there’s a hx of an unexplained FD. Or if there’s some kind of ACOG indications

103
Q

When should a vag delivery PP patient follow up in clinic?

A

6 weeks later. Address lochia, voiding, BM, bfing, PPD, contraception. If having stress incontinence 6 weeks PP consider pelvic floor PT

104
Q

When should a section PP pt FU?

A

2 and 6 weeks. Do an incision check

105
Q

When should we see a PP pt w/ gestational HTN back in clinic?

A

4 days. Preeclampsia can last 6 weeks post delivery. Plus, the cure for preeclampsia is delivery. So you want to make sure that the crazy high BP meds they needed pre-delivery are still necessary now, so you don’t bottom out their pressure since they don’t have preeclampsia anymore. Makes sense?

CM III Exam III (8 decks)

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